Tag Archives: treatment

I am currently writing on the ‘therapeutic alliance’ – its relation to mindfulness, psychotherapy, understanding, and ‘being listened to…’ What follows is an interesting article that I came across that may interest some of you…

Excerpt:

Have you ever tried to change the way you do something? It could be anything — the way you hold your tennis racket, blow into a flute, meditate — you name it. If so, think about that experience. No matter how motivated you were to change, and no matter how much you knew that it would help your serve, musicality, or sense of inner peace, it can be difficult and scary to change even the smallest thing. In order to change, you have to give up your old way of doing something first and then try the new way. That means that for a while you’re in a free fall — you no longer have your old habit to rely on and you don’t yet have the new one.

The anxiety of trying to change something as complex and entrenched as how you relate to people close to you or manage stress takes the feeling to a whole new level. Yet, that’s just what you do when you enter psychotherapy. Just as you had to put yourself into the hand of your teachers and coaches, in therapy you need to gradually do just that with your therapist to help you through what can be a harrowing adventure. The foundation for therapy is called the therapeutic alliance (1, 2). When it’s there, you know that your therapist is there to help you, no matter how hard the going gets.

The therapeutic alliance might be the most important part of beginning a psychotherapy. In fact, many studies indicate that the therapeutic alliance is the best predictor of treatment outcome (3-5).

The Red Book has been described as Jung’s creative response to the threat of madness, yet it has also been seen as a deliberate exercise in self-analysis. I believe it’s likely both. When creating The Red Book, Jung knew he was on the verge of madness, and he also knew his analytical skills and expertise as a psychiatrist were his best chance at alleviating suffering, if not creating the conditions for transformation.

In many regards, The Red Book reads like a healing journey — a phrase often used to describe the reclaiming of self after a history of abuse — which is a transformative period that happens for many people committed to overcoming early life trauma. On the way to an authentic self there is first the need to step away from the person one became to survive abuse. Those confronted with this journey often experience a period of ‘going crazy’ on their way to establishing an authentic sense of self.

As The Red Book shows, individuation is a blessed curse. It opens the way to becoming one’s authentic self, and yet also the risk of alienation from the ‘tribe’. Childhood trauma survivors often know this conundrum intimately. Transformation requires a significant reorienting away from the beliefs, feelings, fantasies, and body states that made possible living in traumatizing conditions. Invariably, there is a part of the self that has gone unacknowledged or rejected, and aches to be reclaimed.

In The Red Book Jung found a process for continually rediscovering authenticity. As he often remarked, individuation is an ongoing journey and not an endpoint reached. Jung also intimated the need for what I called in an earlier post leaps of faith: turning away from the larger world’s expectations and towards one’s inner world of wisdom with acceptance and curiosity.

This quote from The Red Book inspires the impulse to creatively go forth into all that you are:

“Woe betide those who live by way of examples! Life is not with them. If you live according to an example, you thus live the life of that example, but who should live your own life if not yourself? So live yourselves.

“The signposts have fallen, unblazed trails lie before us. Do not be greedy to gobble up the fruits of foreign fields. Do you not know that you yourselves are the fertile acre which bears everything that avails you?”

Jung knew such a ‘leap of faith’ is not easy. He also wrote:

“To live oneself means: to be one’s own task. Never say that it is a pleasure to live oneself. It will be no joy but a long suffering since you must become your own creator.”

But he gives helpful advice for the journey, particularly how to live if the world feels contrary to whom you are becoming. Then you must learn to be your own guide:

“To certain things of the world I must say: you should not be thus, but you should be different. Yet first I look carefully at their nature, otherwise I cannot change it. I proceed in the same way with certain thoughts. You change those things of the world that, not being useful in themselves, endanger your welfare. Proceed likewise with your thoughts. Nothing is complete, and much is in dispute. The way of life is transformation, not exclusion. Well-being is a better judge than the law.”

Reprinted in full with permission by the original author Laura K. Kerr, Ph.D, who moderates the blog, Trauma’s Labyrinth: Finding Ways Out Of Trauma. Laura K. Kerr is a mental health scholar, blogger and trauma-focused psychotherapist. [Her] focus is on healing, with special attention to trauma, modernity, and mental health systems of care.

Living with persisting trauma memories is tough. Involuntarily triggered by events, or people, or places, or thoughts, or feelings . . . well, anything can be a trigger, actually . . . these intrusive, searing memories will turn one’s life inside out. Recovery from traumatic experience is tough as well, and achieving a sense of safety is essential to successful recovery. Rothschild’s brief, personable, and accessible book directly targets safe, successful recovery in a way that compels and convinces the reader. If trauma memories impact your life or that of someone you know or treat in a healthcare setting, you need this book. Because of the importance of this material, and because I want this to be a bit more than a mere review, I will be discussing this book in a two-part post…

There are so many stories of unjust treatment, and this blog will not watch prejudice, abuse or misuse of power without writing about it. The knowledge and insights we want to share, can hopefully be of inspiration and broaden the reader’s mind even more. The more knowledge we have, the stronger we become. Remember, one person can do great things (think of M. Teresa & M. Gandhi), but before anyone can do anything, it`s important to learn as much as possible about the world around us. We cannot do anything before we know what needs to be done, and cannot help without understanding people and their specific world. There are so many perspectives out there, and we hope to show you some of them. That`s the reason our guest bloggers are much appreciated, and even more importantly, the readers of this blog who are free to give feedback on what this blog suffers from and what we should continue with.

Unjust systems, laws and use of power

Unfortunately, there is still much unjustice in the world, much of which we feel powerless against (often using cognitive dissonance to protect us from that feeling) since strong leaders and serious problems in the world make us feel helpless. But, this is not so. Sometimes we forget how much power we have, just by speaking up and getting others on board, a lot can change.

we can`t keep silent

Jerry Alataly writes: One would believe, if justice was blind and treated all people equally, that there would be equal punishment which matched the total amount of harm from the offense of the many people who commit crimes. We like to think that there is fairness in the legal system, where nobody receives any type of special treatment; everyone is given the same opportunity to defend themselves, and, when guilt is proven beyond a reasonable doubt, face the consequences of their actions. Punishment. Like we know, this is not always so. Don`t panic from all unjust treatment. Take a deep breath, and find the warrior inside you: Paulo Coelho “Warrior Of The Light”: Then the Warrior thanks his travelling companions, takes a deep breath and continues on, laden with memories of an unforgettable journey. His heart is sad, but he knows that his sword is sacred and that he must obey the orders of the One to whom he offered up his struggle (from Jeff Nguyen):

Example of a social problem:

610 million people are registered as disabled worldwide. All around the world, existing stereotypes, fears and prejudices have excluded them from equal opportunities. They are often discriminated, marginalized, or treated with pity and welfare.

Overwhelming? Look here for comfort: Founded in 1988, Dialogue in the Dark (DiD) is an international social enterprise that has reached more than 6 million people in over 160 sites and 30 countries around the world. DiD focuses on promoting the ability of the disabled and creating more than 6000 jobs for the visually impaired worldwide.

Saving someone`s day, might not even cost much time and effort. One man, for example, simply stopped by a car who did not have more gas, pulled out his extra gasoline tank, and gave them enough gasoline to continue.

Do you have examples of what one person can do? Or would you like to guest blog here, and thereby enlightening more minds ready to be transformed? Feel free to email us at: forfreepsychology@gmail.com

Taming Obsessive Thoughts

Have you ever gotten a thought stuck in your brain, akin to an awful pop tune from the eighties that just keeps replaying in your mind and won’t go away? A person I’ll call Rachel came to me to help her with a horrifying obsessive thought that was starting to affect her daily functioning. In it, she was being destroyed by a plague of locusts, much like the one that had attacked Egypt in biblical times.

A successful physics professor at a West Coast university, Rachel needed professional help for this recurring, obsessive thought, which had become so vivid over the years that living with it had become almost unbearable. She tried five years of psychotherapy, and then switched to a psychiatrist, who recommended medications that were ineffective and caused unpleasant side effects. Finally, the patient tried a “geographic cure”– a sabbatical to New York. But Rachel continued to experience the terrifying obsessive thoughts. At that point, she was referred to me.

As always, I took a thorough history. I then explained the type of treatment I had in mind. The time frame was to be three or four sessions lasting 90 minutes each. I planned to apply two cognitive techniques and one behavior modification strategy to treat the patient’s obsessive thoughts.

First, we discussed the P&P (possibility and probability) concept. There was certainly a possibility that the locusts could attack her (this generated some humor), but the probability of this happening was significantly slim. As a physicist, she easily related to that concept. That discussion lasted about 30 minutes.

Next, we discussed Newton’s third law of motion: For every action, there is an equal and opposite reaction. When translated into her treatment strategy, this became “for every thought, there is an equal and opposite thought.”

She easily accepted that theory, and it helped to relieve the anxiety of her obsessive thoughts. Taken further, that concept evolved into thinking that for every thought there is a lesser thought — and possibly even no thought. The no-thought concept helps the patient get long-term relief from the obsessive thought.

Finally, we applied the practice of thought stopping. Thought stopping is a method in which the patient induces the thought that is so distressful and is then taught how to stop it. We used guided imagery to induce the terrifying thought of the locust attack.

Here’s how it worked: I asked Rachel to imagine a large movie screen, onto which I invited her to project the scene she had so often envisioned. As she progressed into this stressful imagery, I made a loud noise by hitting my desk with a ruler and simultaneously shouting “Stop!” In that procedure, the image she was thinking or projecting was automatically interrupted, blocked, and stopped. We practiced several times. After six trials, I stopped using the ruler and just shouted “Stop!” It worked. As we proceeded through this technique, Rachel began to take over the entire strategy and began to shout the word “Stop” to control the obsessive thought.

Moving along, we reached a point at which she was able to subvocalize the word “stop” and get the same result as if an outside force had interrupted, blocked, and stopped the thought.

Rachel’s treatment was completed in three 90-minute visits. She was quite pleased that she had gained control over her obsessive thoughts. To reinforce our work together, we audio taped the sessions so she could review them whenever the obsessive thinking began to recur. Having learned how to use the movie-screen approach to project an obsessive thought, Rachel now had a tool she could use on her own. I explained that she could also change images from the obsessive thought to a pleasant scene to help reduce the anxiety that the thought produced.

When Rachel returned to her university, she resumed her thriving and demanding academic career free of that terrifying obsessive thought.

Behavioral treatments like these are hard work, for both the therapist and the patient. Often, we need to structure the treatment to the patient’s thinking, career, and lifestyle, as I did in this case by using the laws of physics for the physics professor. In this, as in so many cases, I am continually amazed at how resilient and changeable the human mind is when people really want to heal, and customized cognitive and behavioral approaches have proven time and again to provide a quick and effective solution.

* * * * *This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

Cognitive restructuring is a core part of Cognitive Behavioral Therapy (CBT). CBT is one of the most effective psychological treatments for common problems like depression, anxiety disorders, and binge eating. Here, clinical and social psychologist Alice Boyes shares some CBT techniques you can try at home to reduce problems with mood, anxiety, and stress.

Practice Noticing When You’re Having a Cognitive Distortion

Choose one type of cognitive distortion to focus on at a time. Example: you recognize that you’re prone to “negative predictions.” For a week, just notice any times you find yourself making a negative prediction—for example, you might notice yourself expecting not to enjoy a party, expecting to feel too tired to exercise, expecting that your boss won’t like an idea, etc.

When you find yourself having the cognitive distortion, ask yourself: what other ways you could think? For the negative predictions example, you might ask yourself what other outcomes are possible. Try these three questions: What’s the worst possible thing that could happen? The best possible thing that could happen? The most realistic?

Track the Accuracy of a Thought

Example: Your rumination-related thought is “If I think a lot about my problem, it’ll help me find a solution.” For this example, you might write down each time you notice yourself ruminating (overthinking) in one column, and in a second column note if the rumination actually lead to useful problem solving.

At the end of the week, determine what percentage of the times you ruminated it led to useful problem solving? Another great idea is to record the approximate number of minutes you were ruminating each time you notice it. Then you can determine how many minutes of rumination you did for each useful problem solving idea.

Behaviorally Testing Your Thought

Example: Your thought is “I don’t have time to take breaks.” For a week (week 1), you could follow your usual routine and at the end of each day, rate your productivity on a 0-10 scale. For week 2, you could take a five minute break every 60 minutes and do the same ratings. You would then compare your productivity ratings across the two weeks.

Evaluate the Evidence For/Against Your Thought

Example: Your thought is “I can never do anything right.” You could write one column of objective evidence (column A) that supports the idea that you can never do anything right, and one column of objective evidence that your thought is not true (column B).

Then, you’d write a couple of balanced thoughts that accurately reflect the evidence, for example: “I’ve made some mistakes that I feel embarrassed about but a lot of the time, I make good choices.” You don’t need to completely believe the new thoughts. For a start, just experiment with trying them on for size.

Mindfulness Meditation

Mindfulness meditation involves picking a focus of attention, such as your breathing. For a set number of minutes, you focus on experiencing the sensations of your breathing, as opposed to thinking “about” your breathing.

Whenever any thoughts come into your mind, gently (and without self-criticism) bring your attention back to experiencing the sensations of your breathing. Mindfulness meditation isn’t specifically a tool for cognitive restructuring but it’s a great way to train yourself to be mindful (aware) of when you’ve become lost in thought. Mindful awareness of what thoughts you’re having is an essential first step in cognitive restructuring.

Self-Compassion

Self-compassion involves talking to yourself kindly whenever you have a sense of suffering. Like mindfulness meditation, self-compassion isn’t specifically a tool for cognitive restructuring, but it has that effect.

Example: you’ve done something silly and normally you’d call yourself a “stupid idiot.” Instead you take a self-compassion approach. You acknowledge you’ve made a mistake, that you feel embarrassed, and that this is part of the universal human experience. Over time, if you replace self-criticism with self-compassion, your thoughts will change. As you do this, you might notice your thoughts about other people becoming kinder and more accepting too.

Dr Alice Boyes’ PhD research was published in the world’s most prestigious social psychology journal – Journal of Personality and Social Psychology. She is originally from New Zealand but is now a digital nomad. She writes about social, clinical, positive, and relationships psychology topics for various outlets including Psychology Today, Women’s Health, and on her own blog. Follow her on Twitter @DrAliceBoyes.

We spend most of our lives trying to be happy. And yet when we’re feeling sad we put on a tear-jerker tune and wallow in our misery. Why?

It’s an aspect of the psychology of music that’s been surprisingly overlooked. Now Annemieke Van den Tol and Jane Edwards at the University of Limerick have surveyed 65 adults online about a time they’d had a negative experience and then chose to listen to a sad piece of music. Most of the participants were Irish but there were also respondents in the Netherlands, USA, Germany and Spain. The age range was 18 to 66 (average 26) with 30 women.

Because this issue has hardly been investigated before, the researchers opted for a qualitative approach. They analysed the participants’ descriptions and looked for recurring themes in why they chose to play sad music.

Van den Tol and Edwards felt that the answers fell into two main overarching themes – the strategies people adopted in selecting sad music, and the functions served by the music.

Among the strategies was the desire for connection. People wanted to listen to music that matched their current mood. “I didn’t want music that would cheer me up, I wanted to stay with those emotions for a while until I was ready to let go of them,” said one 25-year-old female participant. This notion fits with past research showing that people’s current mood is often a better predictor of their choice of music than their desired mood.

Another strategy was using sad music as a memory trigger – to experience nostalgia or feel closer to a person who was missed. “I selected the music because I know he [the person who had died] had liked the music too,” said a 48-year-old female.

Other participants described selecting sad music for its aesthetic value. In this case people weren’t choosing the music to enhance their own sadness or to reminisce, they simply thought the music was beautiful and high quality.

The final strategy related to the message communicated by the sad song. These were often tracks that were sad but conveyed a hopeful message. “The Waterboys song: to me it seems to channel my emotions, and the lyrics give me a sense of hope,” said a 31-year-old male.

The self-regulatory functions of listening to sad music were closely related to the above strategies. So, for example, participants spoke of the re-experiencing of their affect. “I was at home, feeling sorry for myself … though I could not cry,” said a 24-year-old female. “So I decided to play some sad music in order to cry a little and then feel relieved and move on.” A 21-year-old lady put it like this: “the music would encourage me to feel the pain as it were, plus allow me to have a good cry for myself … It probably did not make me feel better at the time, but may have helped me cope overall.”

Another function the researchers labelled cognitive. This included a sense induced by sad music of “common humanity” – seeing one’s own feelings as part of the larger human experience rather than lonely and isolating.

There were also participants who saw sad music as a friend, as if it were empathising with their suffering. “I felt befriended by the music,” said a 33-year-old woman. “By this I mean that if you were to pretend the music/lyrics was a real person, with its lyrics of understanding friendship, comfort and confidence, then surely the song would be your best friend.”

Other identified functions were mood enhancement, retrieving memories, andsocial, which had to do with feel closer to loved ones. Sad music also acted as a distraction. In this case, participants described how sad music allowed them to escape silence. Jolly music was unthinkable, but a mournful tune broke the silence and created a distance from one’s own negative emotions.

Van den Tol and Edwards said their survey provided the perfect springboard for more research into this topic. Future research “could examine the actual effects of music listening in a real life setting,” they suggested, “and how the achievement of self-regulatory goals relate to changes in affect, cognition, and behaviour.”

Do you like listening to sad music when you’re feeling down? What effect does the music have on you?

_________________________________

AJM Van den Tol, and J Edwards (2013). Exploring a rationale for choosing to listen to sad music when feeling sad. Psychology of Music DOI: 10.1177/0305735611430433

Games that are not games. There is a serious barrier to the effective gamification of mental health. This barrier is that the games we psychologists and health professionals are coming up with are not fun. In fact, they are totally uncool, border on the condescending, and wouldn’t motivate anyone to play for more than 30 seconds. This is the case even though the bar is set quite low because these “games” address things that people really want, like boosting our intelligence and memory, reducing depression and stress, quitting smoking, … fill in the blank. I’ve been fascinated with this disconnect between Psychology’s view and real-world acceptability. This disconnect is plaguing other fields as well, such as in the development of “serious games” for education. In this larger context, I’ve been working on the development of an app that takes a scientifically proven approach to reducing stress and anxiety, and embeds the “active ingredient” of this intervention into a game that is fun – fun enough, we hope, for someone to want to play for much more than 30 seconds.

What would it be like if we created mental wellness tools, or even interventions for serious mental health problems, that were truly fun and that could become part of our array of habits and strategies for feeling better, reducing symptoms, performing more efficiently, or dealing with stress? These games, if “snackable” would become our pocket rituals, our chill pills. We could take out our device for 5, 10, or 15 minutes and be empowered to bring about a targeted, appreciable positive impact. The barriers to use should be minimal, the experience intrinsically rewarding – that is, it feels good to play – as well as reinforcing because it helps us meet our health goals. I think many psychologists feel that this approach is not easily conducive to a rigorous scientific approach. But if we fail to find a way to do this – good science and giving people tools they want to use – then the whole endeavor is dead in the water.

This is not meant to be used for diagnostic purposes. If you think you might have PTSD it is recommended to seek professional help. PTSD is a common mental health issue, that can be treated with several methods. If the symptoms keep you from living a normal life, professional help might be needed.

Post-Traumatic Stress can occur after a significant incident that is out of the ordinary. A person involved in such an event might have witnessed an injury or death. You might have been in danger of this yourself. It could have been a large scale disaster, or a small but significant accident. For example:

Being attacked or assualted

A road traffic accident

A house fire

An incident at work

A natural disaster

An initial reaction to such an event might be shock and disbelief. Over time this can fade. More troubling thoughts and feelings can emerge. These might include anger, helplessness or fear. It can be difficult to process your memories of the event, or understand what happened and why. You might re-experience the incident through intrusive flashbacks or nightmares. Following such an experience, it is also common to avoid things that remind you of the incident.

What keeps Post-Traumatic Stress going?

Following an incident you may find that avoiding the location, activity or people involved is an effective way of coping with your distressing circumstance. In the long-term this may not be helpful. Adapting your behaviour to avoid those things might maintain your difficulties, rather than resolving them by working through the problem.

When looking more closely at what stops us from overcoming Post-Traumatic Stress, it becomes clear that our behaviour, thoughts, feelings and physical sensations all interact and combine to keep it going.

Challenging unhelpful thoughts

The way that we think about things has an impact on our mood. Many of these thoughts occur outside of our control, and can be negative or unhelpful. It is therefore important to remember that they are just thoughts, without any real basis, and are not necessarily facts. Even though we may believe a lot of our unhelpful thoughts when we have experienced a traumatic event, or feel stressed or low, it is good to remember that they should be questioned as they are often based on wrong assumptions.

The following section will help you begin to recognise if you are thinking about things in an unhelpful or unrealistic way, and discuss how you can start to make changes to this. By doing so, you can learn to see things in a more realistic light which can help to improve your mood. You might have unhelpful thoughts about all kinds of things. Here are some examples:

About Yourself / Your Actions and Thoughts:

I may not be able to cope

I’m helpless

I’m in danger, something might happen to me

I am to blame

About the World

The world is dangerous and threatening

The world is an unpredictable place

It is clear to see how this kind of thinking might bring your mood and confidence levels down.
You might find it difficult to identify an unhelpful thought. Try thinking about a time when your mood changed, perhaps when you were thinking about a traumatic event. Consider what was running through your mind at that time.

How to challenge unhelpful thoughts

Once you have recognised an unhelpful thought the next stage is to challenge it. To do this, you can ask yourself a serious of questions. See the example below:

Situation: Taking a walk in the evening along a path.

How you feel: Fearful, on edge, worried.

Unhelpful thought: I’m going to be attacked!

Challenges to an unhelpful thought

Now you can challenge your unhelpful thoughts by asking these questions.

Is there any evidence that contradicts this thought?

I’ve walked this way many times before.

Lots of people walk this way.

What would you say to a friend who had this thought in a similar situation?

Lots of people walk there, there’s no reason why you would be targeted.

What are the costs and benefits of thinking in this way?

Costs: It makes me anxious to walk that way home, any other way is much longer. It reminds me of when I was attacked before.

Benefits: I can’t really think of any.

How will you feel about this in 6 months time?

I’ll probably look back and laugh about how silly I was being.

Is there another way of looking at this situation?

I’ve walked this way so many times – it’s completely safe.

Once you have asked yourself these questions, you should read through your answers. Try to come up with a more balanced or rational view. For example:

I have walked along here plenty of times, it is no less safe than it was before I was attacked on that one occasion. I can manage these feelings of anxiety.

Try to apply these questions to the unhelpful thoughts that you notice. It can help to improve your mood. You can use this technique to test your thoughts are realistic and balanced.

Treatment of PTSD is to challenge the unhelpful thoughts and exposing oneself to the scary thoughts or situations. One can try much of this alone, but sometimes it can be even better to plan this together with somebody else, like a therapist or someone you trust. The important thing is to not escape from what scares you, and sometimes that is easier together with others.

Looking after yourself – making sure that you have some time to yourself. For example going for walks, having a relaxing bath, etc.

Relaxation

It is important to make time to relax and do activities that are enjoyable. This can help to improve your mood by calming the body and mind. It can also help you to sleep. Without taking the time to unwind, it is easy to feel overwhelmed and stressed.Relaxation can involve doing something that you enjoy, or just being by yourself. Good examples might be reading a book or having a bath. Exercise is also particularly effective at helping us to relax. What you do does not really matter. Try to choose something that you will look forward to and that gives you a break. Doing an activity that you enjoy will also give you less time to spend worrying. Here are a list of activities that might help you to relax.

Children are so vulnerable. Especially when born into a new world, when thousands of impressions have to be taken in and analyzed. Some things are more important than others, for example figuring out who you shall seek when you need help. Without help you will die, and therefore social processes like recognizing faces, smiling and connecting are very important.

The fact is that caregivers who habitually respond to the needs of the baby before the baby gets distressed, preventing crying, are more likely to have children who are independent than the opposite (e.g., Stein & Newcomb, 1994). Soothing care is best from the outset. Once patterns get established, it’s much harder to change them.

This video shows a baby interacting with his mother, and how strongly the child reacts if the mother doesn`t respond emotionally in her behavior. Not noticing a baby has such an effect, that it can easily be seen after just one minute. It`s tough to look at, but shows how important interaction is!